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Title: The role of medial calf perforating veins in the development of chronic venous insufficiency and ulceration
Author: Stuart, Wesley P.
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2002
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The procedure of open perforator ligation was popularised by Linton and Cockett but became less favoured as it was associated with frequent wound complications, prolonged stay in hospital and mixed results in reported series. Two technological advances have resulted in the impetus to reappraise the indications for surgical interruption of calf perforating veins. Duplex ultrasound is a non-invasive investigation that has allowed anatomical and functional information on blood vessels and flow to be gathered safely and painlessly. Secondly, minimal invasive surgical instrument technology allows interruption of the medial calf perforating veins with expectation of reduced complication rates. The aim of the present work therefore, is to define the role of calf perforating veins in the development of the complications of chronic venous insufficiency. Deteriorating clinical status of the limb was associated with increasing number and maximum diameter of medial calf perforating veins. The number and proportion of these vessels demonstrating bidirectional flow (incompetence) also increased with deteriorating clinical findings. Incompetent calf perforating veins were found to be associated with main stem venous reflux in the superficial and deep systems, but were rarely found as the sole venous abnormality. Surgical correction of the main stem venous reflux resulted in the correction of the physiology in the majority of incompetent perforating veins (IPV). The minimally invasive approach to the interruption of IPV showed several advantages over the open approach in terms of documented complications and post-operative stay in hospital. The present work demonstrates associative evidence of a link between the presence of IPV and the development of the complications of chronic venous insufficiency, evidence that saphenous surgery alone will correct IPV physiology without direct intervention to perforators, if the deep system is normal, and also evidence that minimally invasive perforator surgery is associated with few complications over and above those expected for routine varicose vein surgery.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available